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Waiting times in California's emergency departments
Susan Lambe1, Donna L Washington, Arlene Fink
1Robert Wood Johnson Clinical Scholars' Program, University of California, Los Angeles, CA 94143, USA. slambs@itsa.ucsf.edu
Insights
Emergency department (ED) wait times often exceed one hour, especially in poorer neighborhoods. Longer waits are linked to lower staffing ratios, suggesting a need for improved physician and nurse allocation.
Area of Science:
- Health Services Research
- Emergency Medicine
- Public Health
Background:
- Emergency department (ED) crowding is a growing concern.
- A national survey defined crowding by wait times exceeding one hour, a threshold linked to adverse outcomes.
- Limited data exist on ED waiting times across diverse hospital settings in specific regions.
Purpose of the Study:
- To investigate ED waiting times in a diverse sample of California hospitals.
- To identify factors associated with prolonged patient waits in emergency departments.
Main Methods:
- A random sample of 1,798 patients across 30 California EDs were observed.
- Waiting time was defined as the interval from ED arrival to initial physician or midlevel provider contact.
- Statistical analysis, including ordinary least squares regression, was used to identify predictors of wait times.
Main Results:
- The average ED wait time was 56 minutes, with 42% of patients waiting over 60 minutes.
- Significantly longer wait times were observed at hospitals in lower-income neighborhoods.
- Decreased physician and triage nurse staffing ratios correlated with increased waiting times.
Conclusions:
- ED waiting times frequently surpassed the one-hour threshold considered critical.
- Socioeconomic factors and hospital location significantly impact ED wait times.
- Further research into physician and nurse staffing levels is recommended to mitigate long waits.
Study Objective:
Many perceive emergency department crowding as a significant problem that is getting worse. A national survey of ED directors defined crowding, in part, as waiting more than 1 hour to see a physician, a wait considered likely to result in adverse outcomes. Yet few data are available on ED waiting times among a heterogeneous group of hospitals serving a distinct geographic region.
Methods:
We observed a random sample of 1,798 patients visiting 30 California EDs between December 15, 2000, and May 15, 2001. We defined waiting time as the interval from ED arrival to first contact with a physician or midlevel provider.
Results:
Patients waited an average of 56 minutes (95% confidence interval [CI] 52 to 61 minutes; median 38 minutes); 42% waited longer than 60 minutes. Ordinary least squares regression analysis revealed that waiting times were significantly longer at hospitals in poorer neighborhoods: For every 10,000 dollars decline in per capita income, patients waited 10.1 minutes longer (95% CI 1.8 to 18.4 minutes; P=.02) after adjusting for hospital ownership, teaching status, trauma status, proximity to a recently closed ED, ED volume, patient severity, and age. Lower ratios of physicians and triage nurses to waiting room patient were also associated with longer waits.
Conclusion:
Waiting times often exceeded the threshold set by a survey of ED directors. Further study is required to examine factors that lead to longer waiting times at hospitals in low-income areas. Physician and nurse staffing should be investigated as a means of reducing waiting times.